Editor's
note: Welcome to the Global Health page. The purpose of this feature is
to raise awareness of global health issues with an academic spirit to
help improve the quality of care provided to patients. E-mail
globalhealthnews@musc.edu.

by Andrea P. Summer, M.D.
This month’s feature is Afghanistan, a landlocked, mountainous country
located in the center of Asia. College of Medicine student Obaidullah
Aseem highlights some of the health challenges in Afghanistan,
including inadequate infrastructure, ongoing security problems, and
fragmentation of the health delivery system.

A fact many find surprising is that Kabul, Afghanistan’s capital, was a
vibrant cosmopolitan city rich in culture and art prior to the Soviet
invasion in 1979. Furthermore, in the 1970s many Afghan women were
professionals and a vital part of the economy. Today, however, the
literacy rate for females in Afghanistan is only around 15 percent.
Unfortunately, the majority of social indicators are just as dismal,
thereby affording numerous opportunities for the international
community to contribute to the rebuilding of Afghanistan and the
repatriation of skilled Afghans to their homeland.

Announcements
MUSC International Bake Sale: 11:30 a.m. to 1 p.m., Friday, Dec. 5,
University Main Hospital, across from Starbucks. The bake sale will
feature sweet and savory goods from around the world.

Hope Lodge Dinner: 6 to 8 p.m., Tuesday Dec. 16. The dinner is hosted
by International Student Association and the International Association
from proceeds raised from the International Bake Sale. MUSC
international volunteers are needed to set up dinner and visit with
patients and their families.

For information, e-mail muellemr@musc.edu or call 792-2156.

Health care: an issue of accessby Obaidullah AseemStudent, College of Medicine
From its populous cities to its simple villages, from its sophisticated
city dwellers to its traditionalist villagers to its nomadic Kuchis,
Afghanistan in many ways is a country of extremes. In these
extremes, it is very difficult to talk about health care, because there
are no standards.

Health care, like many of Afghanistan’s problems, is exacerbated by
years of instability, war and lack of a basic infrastructure.
While in the cities, people have reasonable access to doctors and
hospitals, but in the villages where the majority of Afghans live
are isolated from this modern necessity. Two-thirds of
Afghanistan is wrapped in lofty, rugged, dry mountains that isolate
villages and make them inaccessible, especially in winters. In
the Badakhshan province, for example, where one out of nine women die
during childbirth, villagers have to hike through miles of the mighty
Hindu Kush Mountains to get to the only hospital in the province.

The nomadic Kuchis are another group of victims of a non-existent
infrastructure. Much like the Native Americans in the past, they
migrate from region to region semiannually in search of suitable
climate and grazing ground for their livestock on which their living
depends. Their access to health care remains as limited as it was
decades ago.

When the United States and its allies ousted the Taliban in 2001, they
brought many promises of a better life for the ordinary Afghans. Since
then billions of dollars have presumably gone into Afghanistan for
health care. Yet outside the major cities there is little improvement
to show for it. Afghanistan remains a country with the highest
maternal-child death rate outside Africa and one of the few places
where diseases like polio have not been eradicated. Many parts of
Afghanistan, a country once at the crossroads of east and west and the
heart of the silk route, are isolated in every possible way. At this
point, Afghanistan’s health care is a simple matter of access.
How that access is to be provided is a far more complicated matter.

Afghanistan facts

Afghanistan was founded in 1747 and is a mosaic
of ethnic minorities: Pashtun (42 percent), Tajik (27 percent), Hazara
(9 percent), Uzbek (9 percent), other (13percent).

The majority of health care in Afghanistan is provided by nongovernmental organizations (NGO’s).

Afghanistan was at the very heart of the ancient Silk Road, a passageway for riches and ideas between Europe and Asia.

Afghanistan is considered to be the source of
the best lapis lazuli, an intense blue gemstone often referred to as
the stone of friendship and truth.

Clinician’s corner
A 32-year-old male serving in the military recently returned from a
tour in Kabul, Afghanistan and complains of a skin sore on his left
leg. He first noticed the lesion several weeks ago and reports that it
is not painful but is increasing in size. He has not had any fever or
other systemic symptoms. The most likely cause of this patient’s skin
lesion is:
A. Strongyloides stercoralis
B. Leishmania tropica
C. Ancylostoma braziliense
D. Tropical ulcer

The correct answer is B Leishmania tropica. Leishmaniasis is a
parasitic disease transmitted by the sand fly. The disease has three
forms: visceral (affecting the internal organs), cutaneous, and
mucocutaneous leishmaniasis. The cutaneous or skin form is one of the
most important causes of chronic ulcerating skin lesions in the world
and is extremely common in Afghanistan. The lesions are usually
painless unless secondarily infected and can take months or even years
to heal, often leading to scarring. Treatment options are limited and
while they may hasten the resolution of the lesions, they also have
significant side effects, so are usually reserved for more serious
forms of the disease.

Nov. 28, 2008

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